Extensor hallucis longus tendon rupture and reconstruction using allograft tendon: a case report and literature review

Gur Aziz Singh Sidhu; Isabel Bodgener; Jagmeet Singh Bhamra

doi:10.18203/issn.2455-4510.IntJResOrthop20251812

Authors

Gur Aziz Singh Sidhu Department of Orthopaedics, UHL, London, UK
Isabel Bodgener Department of Orthopaedics, UHL, London, UK
Jagmeet Singh Bhamra Department of Orthopaedics, UHL, London, UK

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20251812

Keywords:

Allograft, Extensor hallucis longus, Kessler repair, Tendon injury

Abstract

This case report examined tendon reconstruction using allograft as a treatment approach for chronic extensor hallucis longus (EHL) tendon ruptures, an area with limited existing research. Two cases were discussed to evaluate this method’s effectiveness. The first case involved a 27-years-old male (Patient A) with an EHL tendon tear with retraction up to 2.2 cm and an additional 1.6 cm gap in the extensor hallucis brevis (EHB) tendon confirmed on imaging. The second case was a 28-years-old female (Patient B) with a spontaneous rupture of the left EHL tendon tear with retraction to the tarsometatarsal joint and proximal attenuation extending to the ankle joint. Both patients received reconstruction with an allograft, performed using Kessler’s technique, reinforced with epitenon sutures. Postoperatively, they remained non-weight bearing for four weeks with early range of motion. At the 3-months follow-up, both patients demonstrated active hallux extension and full range of motion, reporting no discomfort during daily activities. Improvements were noted on the American Orthopedic Foot and Ankle Society (AOFAS) Hallux Metatarsophalangeal-Interphalangeal scale and Foot and Ankle ability Measure (FAAM) scores, including the Activities of Daily Living and Sports subscales.

Metrics

Metrics Loading ...

References

Lezak B, Summers S. Anatomy, bony pelvis and lower limb, extensor hallucis longus muscle. 2019.

Wellens EK, Soni C, Karanjia H. Primary transfer of extensor hallucis brevis tendon for repair of extensor hallucis longus tendon rupture. Foot Ankle Surg Techn, Reports Cases. 2023;3(4):100332. DOI: https://doi.org/10.1016/j.fastrc.2023.100332

Al-Qattan MM. Surgical treatment and results in 17 cases of open lacerations of the extensor hallucis longus tendon. J Plastic, Reconstructive Aesthetic Surg. 2007;60(4):360-7. DOI: https://doi.org/10.1016/j.bjps.2006.05.003

Kass JC, Palumbo F, Mehl S, Camarinos N. Extensor hallucis longus tendon injury: an in-depth analysis and treatment protocol. J Foot Ankle Surg. 1997;36(1):24-7. DOI: https://doi.org/10.1016/S1067-2516(97)80006-3

Kim WJ, Jung KJ, Ahn H, Yeo ED, Lee HS, Won SH, et al. Reconstruction of a neglected, extensor hallucis longus tendon rupture using interposed scar tissue: a case report and literature review. International J Envir Res Public Health. 2021;18(22):12157. DOI: https://doi.org/10.3390/ijerph182212157

Legnani C, Borgo E, Macchi V, Ventura A. Autograft versus allograft tenodesis for chronic ankle instability: a single-center retrospective comparative study. J Comp Eff Res. 2020;10(1):5-11. DOI: https://doi.org/10.2217/cer-2020-0070

Wong JC, Daniel JN, Raikin SM. Repair of acute extensor hallucis longus tendon injuries: a retrospective review. Foot Ankle Spec. 2014;7(1):45-51.

Jaffe D. Restoration of extension of the great toe after an untreated, retracted extensor hallucis longus rupture: A Case Report. JBJS Case Connect. 2019;9(4):348. DOI: https://doi.org/10.2106/JBJS.CC.18.00348

Kurashige T. Chronic extensor hallucis longus tendon rupture treated with double-bundle autograft of extensor hallucis capsularis: A case report. SAGE Open Med Case Rep. 2019;7:2050. DOI: https://doi.org/10.1177/2050313X19841962

Kitaoka HB, Alexander IJ. Tendon transfers for hallux extension and flexion. Clin Orthop Related Res. 268;2:191-9.

Scranton PE, Silva MJ. Tendon grafting for repair of foot and ankle tendons. J Am Acad Orthop Surg. 2012;13(6):395-403.

Deese JM, Parks BG. Graft selection in foot and ankle tendon reconstruction: Autograft versus allograft. Foot Ankle Int. 2014;32(4):429-35.

Krych AJ, Dahm DL. The impact of allograft preparation on disease transmission. Sports Med. 2012;38(1):47-57.

Taylor DC, Behn AW. Use of allografts in complex foot and ankle reconstructions. J Bone Joint Surg. 2012;101(2):186-93.

Oseni-Olalemi O, Seo S, Thomas R, Rabadi D, Kirakosian A. Repair of ruptured extensor hallucis longus tendon with a semitendinosus tendon allograft: A case report. Foot Ankle Surg: Techniques, Rep Cases. 2024;4(1):100365. DOI: https://doi.org/10.1016/j.fastrc.2024.100365

Mook WR, Parekh SG, Nunley JA. Allograft reconstruction of peroneal tendons: operative technique and clinical outcomes. Foot Ankle Int. 2013;34(9):1212-20. DOI: https://doi.org/10.1177/1071100713487527

Bastías GF, Cuchacovich N, Schiff A, Carcuro G, Pellegrini MJ. Technique tip: EDL-to-EHL double loop transfer for extensor hallucis longus reconstruction. Foot Ankle Surg. 2019;25(3):272-7. DOI: https://doi.org/10.1016/j.fas.2017.11.005

Wong JC, Daniel JN, Raikin SM. Repair of acute extensor hallucis longus tendon injuries: a retrospective review. Foot Ankle Specialist. 2014;7(1):45-51. DOI: https://doi.org/10.1177/1938640013514271

Yasuda T, Shima H, Mori K, Kizawa M, Neo M. Direct repair of chronic Achilles tendon ruptures using scar tissue located between the tendon stumps. JBJS. 2016;98(14):1168-75. DOI: https://doi.org/10.2106/JBJS.15.00865

Drogset JO, Størset KH, Nitteberg TM, Gifstad T. Clinical outcome after knee ligament reconstruction with tendon allografts. J Experim Orthopaed. 2021;8:1-9. DOI: https://doi.org/10.1186/s40634-021-00331-4